Neurological Conditions
Stroke
A stroke, also known as a cerebrovascular insult or accident is a sudden loss of brain function caused by an interruption in the supply of blood to the brain. This can either be caused by a ruptured blood vessel (Haemorrhage) or a blockage in a blood vessel (Cerebral Thrombosis). As a result, the affected area of the brain cannot function normally, which might result in an inability to move one side of the body, difficulty in understanding or formulating speech, or a vision impairment of one side of the visual field.

Traumatic Brain Injury
Traumatic brain injury is a non-degenerative, non-congenital injury to the brain caused by an external force. This results in either temporary or permanent neurological dysfunction, which may be in the form of cognitive, physical and psychosocial impairments, all affecting a person’s normal functioning.

Spinal Cord Injury
Spinal cord injury (SCI) is an injury to the spinal cord resulting in either temporary or permanent damage to the cord’s normal motor, sensory, or autonomic function. Depending on where the spinal cord and nerve roots are damaged, the symptoms can vary widely, from pain to paralysis to incontinence. Spinal cord injuries are described at various levels of “incomplete”, which can vary from having no effect on the patient to a “complete” injury which means a total loss of function.

Parkinson’s Disease
A progressive disease of the nervous system. It is associated with degeneration of the basal ganglia of the brain and a deficiency of the neurotransmitter dopamine. Parkinsons disease is characterised by marked tremors, muscular rigidity, and slow, imprecise movement, mostly affecting middle-aged and elderly people.

Multiple Sclerosis
Multiple sclerosis (MS) is a disease in which the immune system attacks the protective sheath (myelin) that covers the nerves. Damage to the myelin disrupts communication between the brain and the rest of your body. Eventually, the nerves themselves may deteriorate and this process is currently irreversible.

Signs and symptoms vary widely, depending on the amount of damage and which nerves are affected. Some people with severe MS may lose the ability to walk independently or at all, while others experience long periods of remission during which they develop no new symptoms.

Motor Neurone Disease
Motor neuron disease (MNDs) is a group of progressive neurological disorders that destroy motor neurons, the cells that control muscle activity responsible for speaking, walking, breathing, and swallowing.

When there are disruptions in the signals between the motor neurons and the muscle, the muscles do not work properly. The muscles gradually weaken and may begin wasting away and either develop uncontrollable twitching (spasms) stiffness (called spasticity), movements become slow and effortful and over time, the ability to control voluntary movement can be lost.

Guillan Barre Syndrome
Guillain-Barre syndrome is a rare disorder in which the body’s own immune system attacks its nerves. Weakness and tingling in the hands and feet are usually the first symptoms. These sensations can quickly spread, eventually paralysing your whole body. In its most severe form Guillain-Barre syndrome is a medical emergency. Most people with the condition must be hospitalised to receive treatment. Most people recover fully from Guillain-Barre syndrome, though some may experience lingering effects from it, such as weakness, numbness or fatigue.

Complex orthopaedic conditions
Amputations

Upper Limb Amputations

UpperLimbAmputations

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Amputation is the removal of a body extremity by trauma, prolonged constriction, or surgery. There are different causes of upper limb amputations and amputation occurs at different levels. These levels include: Fingers or partial hand (transcarpal), at the wrist (wrist disarticulation), below the elbow (transradial), at the elbow (elbow disarticulation), above the elbow (transhumeral), at the shoulder (shoulder disarticulation), and above the shoulder (forequarter).

Upper limb amputees can often experience phantom limb (feeling that the amputated body part is still attached and moving); phantom limb pain (pain and discomfort of the amputated body part); increased or decreased feeling in the stump; decreased muscle strength in the arm/hand; raised and stuck scar tissue, and difficulty in performing day-to-day tasks.

Lower Limb Amputations

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Courtesy of www.cpousa.com

An amputation is the surgical removal of an arm or a leg or part thereof such as a toe or finger. The amputation can be the result of an injury, disease, infection, gangrene or congenital deformity.

The most common reason for an amputation is poor circulation known as peripheral arterial disease which usually results from diabetes or atherosclerosis.
Other reasons for amputations can be a traumatic injury such as an accident, severe burn or cancerous tumour in the limb.

The treatment plan for an amputee will be discussed on an initial assessment and an appropriate prosthesis will be fitted.

Acute hand injuries

Tendon Injuries
Tendons connect muscle to bone. Tendons and muscle work together to move bones and create movement. Tendons are used to either bend (flex) or straighten (extend) joints i.e. fingers wrist, elbow. There are various injuries that can result in tendons being damaged or cut at different areas of the upper limb. Tendons can be damaged at the finger, hand, wrist, forearm, elbow and upper arm level. This results in loss of movement and use of the hand/arm e.g. closing or opening your hand to pick up or let go of something, bending or straightening your finger.

Fractures
A fracture is referred to as a break in any bone which is a result of i.e. a fall, crush, car accident, or a medical condition. Fractures can be open (bone breaks through the skin) or closed (bone broken without breaking thought the skin) and there different types e.g. complete or incomplete fracture, spiral fracture, linear fracture,transverse fracture, oblique fracture, comminuted fracture,impact fracture or avulsion fracture. A break in the bone will result is swelling and pain around the area, loss of movement at the joint closest to the break and possibly in other joints near the break. With fractures there can also be other structures damaged e.g. skin, muscle, nerves, blood vessels, tendons.

Soft Tissue Injuries
A soft tissue injury is damage to the muscles, ligaments and/or tendons. The most common soft tissue injuries include: sprain (refers to a tear or rupture of the ligaments i.e. of the wrist from falling on an open hand), strains (refer to the tear or rupture of muscles or tendons due to an over stretch), contusions (bruising caused by a blow to a muscle, tendon or ligamnet), tendonitis (swelling around the tendon e.g. tennis/golfers elbow), and stress injuries (results from repetitive use of a joint in a particular activity i.e carpal tunnel syndrome from typing). These are common in sport related injuries.

Soft tissue injuries result in pain, swelling, bruising and loss of movement in the area that has been injured and there may sometimes be changes in feeling.

Nerve Injuries

Chronic Hand Conditions

Carpal Tunnel
Carpal tunnel syndrome is a result of pressure on the median nerve, one of the main nerves of the hand. The carpal tunnel is the tunnel on the palm side of the wrist through which tendons to the fingers and the median nerve travel.

This tunnel is only large enough for these tendons and nerve and any swelling that occurs in this area will result in the tunnel being too small for these structures to fit comfortably inside. An increase in pressure from inflammation in the tunnel will cause pain, numbness, tingling, clumsiness or weakness and swelling in the thumb, index and ring fingers. It usually occurs in a person prone to inflammation and can be aggravated by repetitive and strenuous tasks.

De Quervains Tenosynovitis
De Quervain syndrome (also known as BlackBerry thumb, gamer’s thumb, radial styloid tenosynovitis, de Quervain disease, de Quervain’s tenosynovitis, de Quervain’s stenosing tenosynovitis, mother’s wrist) is a tenosynovitis (inflammation and swelling)of the lining that surrounds the tendons at the thumb.

Common symptoms are pain, tenderness (painful to touch), and swelling over the thumb side of the wrist, and difficulty gripping. It is common in new mothers, overuse of a screwdriver and excessive scissor use

Base of Thumb Osteoarthritis
Osteoarthritis is a joint disease which results in deterioration of the joint surface which leads to pain during joint use. It most often affects the small joints of the fingers and the base of the thumb. The exact cause of osteoarthritis is not known; it is thought to be due to the smooth cartilage on the ends of the bone breaking down. It tends to run in families and can occur after trauma to a joint. Osteoarthritis leads to joint pain on movement and during daily activities. Common symptoms include redness, swelling, stiffness and tenderness of the affected joint.

Common foot disorders
Plantar Fasciitis

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Courtesy of www.nlm.nih.gov

Plantar fasciitis is a common painful foot disorder affecting the bottom of the heel and is most intense with the first steps of the day.
The plantar fasciitis is a thick fibrous bond that runs along the bottom of the foot and connects the heel bone to the toes and creates the longitudinal arch. If there is any problems with the dynamics of the foot, for instance the arch of the foot is too high or flat it causes this tissue to become swollen or inflamed and pain can be felt in the heel or along the arch of the foot.

Metatarsalgia

MetatarsalgiaForeFootPain

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Metatarsalgia is pain in the joint of the ball of the foot. It is made worse by standing, walking or running. The pain can be described as walking on pebbles and can be felt in one, two or all the metatarsal heads. A Morton’s neuroma can develop if the nerve running between the metatarsal bones is impinched or inflamed. The symptoms that can be felt are pain, burning, numbness or tingly between the toes.

Heal Pain / Achilles Tendinitis

AchillesTendinitisHeelPain

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Achilles Tendinitis is the inflammation of the tendon that connects the heel to the calf. The pain is usually felt around the back of the heel or just above the heel. The area can become swollen, tender to touch or walk on, stiff in the morning or difficulty standing up on one toe. This injury is often seen in runners and is caused by overuse of the foot or incorrect training.

Shin Splints / Tibial Stress Syndrome

ShinSplintsTibialStressSyndome

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Shin splints is commonly felt as pain along the shin bone. Shin splints are commonly seen in runners and high school age runners. Shin splints is usually felt after an activity as an ache or pain along inner parts of the lower two – thirds of the tibia.

Ankle Pain

AnklePain

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Sprained ankles are one of the most common musculoskeletal injuries in the foot. These injuries can occur in the young and old, sporty and non-sporty people. They are caused by an un-natural twisting motion of the ankle joint when the foot is placed abnormally on the ground, when the ground is uneven or when an unusual amount of force is applied to the joint.

Diabetic Foot

DiabeticFoot

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A diabetic is at high risk of foot problems due to two main conditions, peripheral neuropathy and peripheral artery disease.

Peripheral neuropathy is the damage to the peripheral nerves caused by diabetes. This causes decreased sensation in the feet and legs making it difficult to perceive injuries due to a lack of feeling. Other symptoms are, tingling, burning or pain sensations in the feet and lower legs.

Peripheral neuropathy can also cause the muscles of the feet not to function correctly, leading to mal alignment of the foot that can put increased pressure on certain areas of the foot.
Peripheral vascular disease is the narrowing or hardening of the arteries. This causes a decrease delivery of oxygenated blood to the lower legs and feet. In sever causes a lack of oxygen to the legs and feet can cause ulcers and even gangrene.

Knee Pain

KneePain

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Knee pain is a common ailment that can be experienced by older adults, young adults and children.

Knee pain from mal alignment like knock knees or bow leg is a biomechanical deformity that can cause pain and weakness whilst doing an activity.

Pronation / Supination

Lower Back Pain

Post mastectomy breast prosthetics
Scarring
Burn Wounds
A burn wound is trauma caused to soft tissue (all tissue other than bone) as a result of burns from heat, electricity, friction, radiation or chemicals. The burn injury will be classified according to its depth. In first degree or superficial burns only top layers of skin affected as in sunburn. Second degree or partial thickness burns the damage penetrates into some underlying layers. In a third degree or full thickness burn the damage penetrates all layers of skin and skin grafting is required to heal the burn. Burns are further classified according to the percentage body surface area burned.

During healing of burn injuries the affected soft tissue will develop scar tissue, this can shorten and limit movement. Both movement and scarring must be monitored.

Hypersensitive Scars
During trauma to soft tissue, whether it be surgical or non-surgical, damage is caused to sensory(feeling)nerves found in the skin. During healing of soft tissue a scar is formed; as this scar is formed so the damaged nerves are growing new nerve endings. These nerve endings may be sensitive to gentle touch and are then classified as hypersensitive. Hypersensitive scars can lead to irritability or extreme discomfort when stimulated. New nerve endings need training to gain normal sensation(feeling).

Keloid Scarring
Scars form following trauma to body tissue. A scar can be classified as a keloid scar if it grows away from the body and beyond the boundaries of the original scar. The keloid scar can be firm, shiny, rubbery, fibrous (hard) and can vary in colour. The keloid scar is not contagious but sometimes results in severe itchiness, pain and changes in texture.

Severe cases can result in a negative effect on movement. Keloid scars are seen 15 times more frequently in highly-pigmented (dark skinned) ethnic groups than in Caucasians.

Vascular Insufficiencies